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This is a reproduction of an article published in the Infectious Diseases in Children Magazine in October 2002

Probiotics could be wave of the future for diarrhea control

Danish study finds probiotics safe and effective in reducing duration of diarrheal illness among day care attendees.

HVIDOVRE, Denmark To help combat growing antibiotic resistance rates, several scientists have begun touting probiotics as the answer.

Dozens, possibly hundreds of varieties of bacteria colonize the body's gastrointestinal and respiratory tracts. Some of those bacteria are harmful types, which trigger immune responses or else release toxins that affect the body's functioning, leading to illness or infection.

But most of the flora on the body's mucosal surfaces are harmless. Antibiotics upset the balance of harmful and benign bacteria.

Scientists are now trying to figure out if reintroducing some of those benign bacteria back into the body could tilt the competitive balance in favor of harmless bacteria. They hope the benign bacteria will proliferate and replace the harmful bacteria on the body's mucosal surfaces, therefore eliminating the need to introduce antibiotics that could perpetuate the cycle of resistance.

In a study conducted here, Lactobacillus species were shown to be effective in reducing the duration of diarrhea among nonhospitalized children attending day care. Previously, studies on the use of probiotics were largely confined to hospitalized children.

Probiotic Lactobacillus

The Lactobacillus GG ATCC 53103 strain has been used in outpatient settings to reduce the duration of diarrhea. In a previous randomized-controlled trial in a day care setting, children who received L. GG in enhanced milk had fewer days of absence and an overall 19% reduction in antibiotic treatments for respiratory infections. Another 17% of treated children had reductions in the number of respiratory infections, otitis media and sinusitis.

Reduced rates of rotavirus excretion have also been noted in patients treated with probiotic Lactobacillus. Although rotavirus is seen as a comparatively minor cause of diarrhea in U.S. children, rotavirus diarrhea is still a significant problem in the developing world, claiming about 600,000 lives annually.

In the current study, rotavirus was found in 63% of the 43 patients enrolled for study. Bacterial pathogens with no concomitant viral infection were identified in two patients and two patients with rotavirus identified in their stools also had bacterial colonization.

The patients were randomized to receive either a placebo or a lyophilized L. rhamnosus 19070-2 and L. reuteri DSM 12246 preparation given in a dose of 1010 colony-forming units twice daily for five days. After the treatment protocol, the average duration of illness among the treated population was 76 hours, significantly lower than the 116 hours in the placebo group. At the end of the intervention (120 hours), two of 24 patients in the treatment group and seven of 19 in the placebo group still reported loose stools.

One or both of the Lactobacillus strains were identified in 65% of stool specimens from treated patients on day six after treatment, according to the study. There were no serious adverse events reported in the study population.

Overall, the use of probiotics resulted in a 45% reduction in duration of diarrheal illness, which could be significant because day care attendees are at increased risk for gastroenteritis and diarrheal illnesses. Treatment was most successful when probiotics were offered early in the diarrheal phase, according to the study.